Desnos M, Hagège A, Guérot C
Service de cardiologie, hôpital Boucicaut, Paris.
Arch Mal Coeur Vaiss. 1995 Apr;88(4 Suppl):573-5.
The development of echocardiography and kindred studies have enabled the detection of an increasing number of asymptomatic forms of hypertrophic cardiomyopathy. Drug therapy, by far the commonest therapeutic method of managing this condition, has only been shown to be effective on the symptoms. Therefore, due to the risk of iatrogenic disease, medication is only proposed to symptomatic patients: high dose betablockers is the usual treatment; when ineffective or contra-indicated, verapamil may be prescribed at progressively increasing doses under strict medical control. These products may need to be given at high doses in order to be effective but excessive bradycardia may be a limiting factor. Amiodarone alone or in association, may be preferred in forms with arrhythmias. The comparative efficacy of the different drugs, especially in preventing sudden death, requires well designed, controlled, therapeutic trials. Their results, if positive, would question the dogma of only treating symptomatic patients.
超声心动图及相关研究的发展，使得越来越多无症状型肥厚型心肌病得以被发现。药物治疗是目前治疗该病最常用的方法，但仅被证明对症状有效。因此，鉴于医源性疾病的风险，药物治疗仅适用于有症状的患者：通常的治疗方法是使用高剂量β受体阻滞剂；若无效或有禁忌，可在严格医疗监控下逐渐增加维拉帕米的剂量。这些药物可能需要高剂量使用才能起效，但严重心动过缓可能是一个限制因素。对于有心律失常的类型，单独使用或联合使用胺碘酮可能更合适。不同药物的相对疗效，尤其是在预防猝死方面，需要精心设计、对照的治疗试验。如果试验结果呈阳性，将对仅治疗有症状患者的教条提出质疑。
